A California state auditor's report shows that nonprofit hospitals have significant leeway in determining how much charity care they provide to the neediest patients. A state Senate committee will discuss that issue and others at a hearing Wednesday as part of the debate over whether nonprofit hospitals do enough to justify their tax-exempt status. Critics have said some nonprofit hospitals skimp on charity care while amassing large reserves and paying hefty salaries to executives. Some nonprofit hospitals have also come under scrutiny for aggressive collection practices against the uninsured over unpaid medical bills.
More than 2,000 hospitals—including some nationally recognized ones —will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show. Together, these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying healthcare providers based on the quality of care they provide. With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don't recover and return for more treatment.
Doctors who order tests for hospital patients don't always read the results before the patient is discharged, raising the risk of missing potentially dangerous conditions, an Australian study found. About half of the unread tests were ordered on the day the patient left the hospital, according to research today in the Archives of Internal Medicine. Many of those results still hadn't been reviewed two months later, the researchers said. Researchers looked at 6,736 inpatient admissions and 662,858 individual medical tests. Of those tests, 3 percent weren't reviewed at discharge and 7 percent were requested on the day the patient was leaving the hospital.
HCA Holdings, the hospital operator being investigated for performing unnecessary heart procedures and billing Medicare for it, has issued a second statement in anticipation of a critical news story by the New York Times that examines the company's emergency room procedures. The notice, posted on the HCA website, says the newspaper has raised questions about the adoption of a set of guidelines for evaluating and managing patients at emergency rooms. HCA seems to be pre-emptively positioning itself amid such statistics when it claims that about half of its 163 hospitals have adopted systems to determine when patients seen at its ERs actually need emergency care.
How does Massachusetts healthcare reform and recently-passed cost containment legislation look from the perspective of an academic integrated delivery system like Partners Healthcare? There are still a few people in Massachusetts without healthcare insurance, but only a few. My colleagues like that—it's hard taking care of uninsured patients, and I don't know anyone who wants to turn back the clock. Massachusetts gets a bad rap for having high healthcare costs, but the fact is that we're relatively efficient compared to the rest of the U.S.
If any state is poised to be ready, it's Maryland. One of the first to pass a law establishing an exchange, back in April 2011, it's moved swiftly to begin building a $51 million computer system that citizens will use to shop for insurance online as they do for airline tickets on Expedia (EXPE). "We want to be the model," says Lieutenant Governor Anthony Brown, who oversees the state's healthcare reform efforts. Yet even with its early lead, Maryland faces big challenges as it tries to assemble all the pieces of the massive law. That computer system the state’s building? It will have to connect seamlessly with both Maryland’s Medicaid system and the federal government's computers.